MRSA Outbreaks Tied to Reuse of Single-Dose Vial Injections

July 13, 2012 — Today’s issue of Morbidity and Mortality Weekly Report from the Centers for Disease Control (CDC) is attempting to raise awareness about the risk of transmitting antibiotic-resistant MRSA bacteria when health care personnel use single-dose vials on multiple patients. The practice commonly occurs when there are drug shortages of smaller-dose vials, forcing clinics to re-use larger doses for many people. Since the CDC began keeping track of this in 2007, there have been 20 outbreaks of MRSA tied to re-use of single-dose vials.

The report described one MRSA outbreak in Delaware in March 2012 at an orthopedic outpatient clinic. The investigation began the Department of Health was notified that a local hospital system had recently received seven patients suffering from MRSA infections following treatment at one orthopedic clinic. The patients were hospitalized for 5-8 days due to severe bacterial infections in their knee, hip, or thumb. All of the patients underwent surgery to remove infected tissues in their joints.

When the health department investigated the orthopedic clinic, they found that two staff members responsible for preparing injections were carriers of the MRSA bacteria. Due to a drug shortage of 10 mL single-dose vials of an anesthetic, these contaminated staff members accessed 30 mL vials multiple times throughout the day and injected patients.

The second outbreak of MRSA occurred in April 2012 at one outpatient pain management clinic in Arizona. The Department of Health was notified that several people were diagnosed with MRSA soon after being treated at one clinic. An investigation revealed that nurses at the clinic were re-using single-dose vials and diluting it into other vials. This resulted in cross-contamination of multiple solutions.

The MRSA infections were very severe, and included bacterial meningitis, epidural abscess, and sepsis. The infections all began 4-8 days after the patients were treated at the clinic. Hospital stays ranged from 9 days to 41 days. One patient required intensive long-term follow-up care. Another patients was discovered deceased at home, and MRSA may have been a factor in the death.

Investigators were unsure how the vials became contaminated with MRSA, but they did find that some personnel did not wear face masks while they were giving epidural spinal injections. Health care professionals may be carriers of the bacteria and spread it to patients.

MRSA (or “methicillin-resistant Staphylococcus aureus”) is a type of highly-infectious staph bacteria that is drug-resistant to the first-line antibiotics that are usually used to treat staph infections. MRSA infections can be very severe, even life-threatening, especially when the bacteria spreads to joints, the blood, or organs such as the heart, brain, or lungs. It is often spread by health care personnel who carry the bacteria and spread it to patients via skin-to-skin contact.

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